Posterior Chamber and Retinal Disorders Flashcards by Angela Roden

What happens in Retinal Detachment?

retinal tear fluid vitreous passes through the tear and lodges behind the sensory retina combined traction and pull of gravity results in progressive detachment

How well did you know this?

Not at all

Perfectly

Predisposing Factors of Retinal Detachment

-50-75years old -myosis -cataract extraction -trauma -Family history -advanced diabetes

How well did you know this?

Not at all

Perfectly

Where does retinal detachment usually begin? What type of vision is lost?

superior temporal area central vision remains intact during initial tear, once the tear progresses to the macula central vision is lost.

How well did you know this?

Not at all

Perfectly

Signs and Symptoms of Retinal Detachment

-blurred vision in one eye becoming progressively worse -floaters (large horsefly) -flashing lights caused by tugging on retinal surface **NO PAIN, NO REDNESS

How well did you know this?

Not at all

Perfectly

What does retinal detachment look like on fundoscopic exam? -initial -progressive

-wrinkled/bubbled wallpaper - gray cloud

How well did you know this?

Not at all

Perfectly

Treatment of Retinal Detachment

-REFER to OPHTHO!!! –cryotherapy –scleral buckle –intravetral gas –vitrectomy

How well did you know this?

Not at all

Perfectly

Central Retinal Artery Occlusion -what is this? -aka -predisposing factors

-emboli enter and occlude the retinal artery Stroke of the Eye Predisposing factors: -age, 60-80years generally, may happen sooner -carotid artery disease -atrial fibrillation -HTN -Diabetes -Temporal Arteritis

How well did you know this?

Not at all

Perfectly

What does CRAO look like on fundoscopic exam?

cherry red spot: macula/fovea (cherry) with pale background (ischemic/dead). Macula=cherry d/t blood supply from Choroid and rest of retina blood supplied from central retinal artery. -arteriole narrowing -PALLOR of optic disc -boxcar segmenting***(PANCE!!!!!!!) -afferent pupillary defect

How well did you know this?

Not at all

Perfectly

Signs and Symptoms of CRAO

-sudden profound monocular visual loss (seconds, minutes, perminant) -can be preceded by amarousis fugax (transient stroke) ** this is the warning sign of CRAO -painless -no redness -visual acuity impairment (can detect hand movements but cant count fingers)

How well did you know this?

Not at all

Perfectly

Treatment of CRAO

-REFER TO OPHTHO!! *prognosis for vision is very poor! (especially if not resolved in 90mins) -ocular massage -anterior chamber paracentesis -revascularization technique –thrombolysis

How well did you know this?

Not at all

Perfectly

Retinal Vein Occlusions -predisposing factors –systemic & Ocular

Systemic- -increasing age -HTN -Coagulation disorders -diabetes Ocular- -raised intraOCULAR pressue (>25mmhg) -vein inflammation (vasculitis)

How well did you know this?

Not at all

Perfectly

Signs and Symptoms Retinal Vein Occlusion

-visual impairment noticed upon waking** (PANCE!!!!) -sudden monocular loss of vision -PAINLESS -diagnosis can be made w/ ophthalmoscopic exam

How well did you know this?

Not at all

Perfectly

What does RVO look like on fundoscopic exam?

-minimal Afferent Papillary Defect (APD) -venous tortuosity/dilation -cotton wool spots -mild to moderatae disc edema -macular edema -varicose veins (dilated)

How well did you know this?

Not at all

Perfectly

Treatment of RVO High risk for what disease?

-REFER!!!! -make sure ongoing follow-up is established with Ophtho. High risk for- neovascular glaucoma/ proliferative retinopathy

How well did you know this?

Not at all

Perfectly

What is neovascular glaucoma? Tx of this.

-development of new little tiny vessels to fulfill the ischemic areas. These new vessels are weak and leaky so they b leed out raising the intraOCULAR pressure in the eye leading to glaucoma. -laser therapy may be good for treating this.

How well did you know this?

Not at all

Perfectly

Amaurosis Fugax -what is this?

-monocular vision loss lasting a few minutes with COMPLETE recovery. -caused from retinal emboli from IPSILATERAL carotid disease. -TIA of the eye.

How well did you know this?

Not at all

Perfectly

Signs of Amaurosis Fugax

curtain passing VERTICALLY across field of vision leading to complete loss of vision, similar curtain effect as the vision returns. (PANCE!!!!!!)

Diagnostic Testing and Labs of Amaurosis Fugax

-doppler US of carotids -CT/MRI angiography -EKG (rule out A. Fib) -Echo Labs- -CBC -Fasting Blood sugar -ESR and CRP -Lipid Profile

Amaurosis Fugax Differential Dx

-impending central retinal artery/vein occlusion -impending OPHTHALAMIC artery occlusion (total retinal blanching) -carotid stenosis (bruit) -temporal arteritis (Giant Cell Arteritis) -ocular migraine (scintillating scotoma)

Treatment of Amaurosis Fugax

-ocular massage

Optic Nerve Neuritis Key clues

-young patient with vision loss and no immediate obvious exam findings -pain w/ eye movements

Signs and Symptoms of Optic Neuritis

-unilateral decreased vision over 1-3 days -occasional pain w/ eye movement -age 18-45 -complete loss of color vision -afferent pupillary defect *these 2 return on own 95% of the time. -Uhtoffs Sign (worsening of neurologic symptoms in MS d/t increased body temperature on nerve conduction, this is painful)

Etiology of Optic Neuritis

-Multiple Sclerosis –optic neuritis is often initial manifestation of MS -idiopathic -Viral infection, TB, sarcoidosis

What does Optic Neuritis look like on fundoscopic exam?

-optic nerve normal, may be swollen but less common -relative afferent pupillary defect -decreased color vision -

Optic Neuritis Work up and Tx

Work up: -complete ophthalmic exam --pupils, color vision, decreased light brightness sensitivity w/ penlight, visual field test. -complete neurologic exam/ MRI & possible IV\*\* steroids (dont use oral steroids--malpractice d/t not aggressive enough, \*anything w/ MS you use IV steroids) (PANCE!!!!!!!) -check BP -ESR, CRP, TA bx if suspect Giant Cell Arteritis (if\>55yo)

Optic Neuritis/MS MRI findings

-may have white plaques in multiple areas or they may not be present at all. -May not get true diagnosis for 15 years

Papilledema -etiology

-intracranial tumors -hydrocephalus -pseudotumor (young obese females) -subdural hematoma (trauma) -Brain abscess/ Meningitis

Signs and Symptoms of Papilledema

- slow vision loss from increased ICP/optic nerve swelling - can have acute attacks of vision when lying flat - usually bilateral - disc margins blurred - peripapillary disc hemorrhages - may have dbl vision if CN VI palsy from increased ICP

Treatmen of Papilledema

-directed at underlying cause

What would you see on Fundoscopic exam of Giance Cell Arteritis?

relative afferent pupillary defect pale, swollen optic disc

Labs to order: Giant CEll arteritis

- difficult to make this diagnosis w/o labs - ESR ( \* usually these are REALLY high, pretty significant lab abnormality. \*go by symptoms; ESR and CRP can be NORMAL in 20% of patients.

Definitive Dx of GCA

Temporal Artery biopsy Histology shows granulomatous inflitrate of internal eslastic lamina of artery. --occlusion of vessel lumen, **giant cells** present

Tx of GCA

-steroids even before biopsy is done (prednisone po qd) \*dont wait for biopsy if suspicious\* - tx is to preserve visual loss of the other eye - if severe sx or visual loss: 1gm solumederol IV x3-5 days then SLOW taper off oral steroids over 2weeks. -refer to surgery for biopsy!

What is Giant Cell Arteritis?

arteries that become inflamed causing them to swell and sometimes decrease blood flow, this decrease in flow leads to vision loss that may be perminant.

Age Related Macular Degeneration - Types - what happens

- 90% dry (slower onset/gradual), 10% wet (sudden) What happens: - "wearing out" of retina/photoreceptors - DRY: degredation products from drusen (white/yellow deposits) in retina beneath macula- - macula degernates over time - WET: neovascularization under the retina growing towards the macula causing it to lift up and pull away from its base. - rare before 50yo - most common in caucasions

Age Related Macular Degeneration -Risk Factors

- age - smoking - family hx - caucasian - sun exposure - diet - HTN - atherosclerosis - cataract surgery

Age Related Macular Degeneration Pt compaints of Wet type

- acute disortion of vision, especially distortion of straight lines or loss of central vision (amsler grid) - symptoms usually appear in one eye although disease is generally in both eyes

Ways to minimize the effects of Age related macular degeneration

- quit smoking - control CVD - healthy diet - antioxidants

Tx of Age Related Macular Degeneration

- monitor vision on amsler grid - antioxidants may prevent cellular damage to retina - Vit C &E - beta carotene - zinc - copper